Spontaneous resolution of an acute epidural hematoma with normal intracranial pressure: case report and literature review

Abstract

Traumatic epidural hematomas are critical emergencies in neurosurgery, and patients symptomatic from acute epidural hematomas are typically treated with rapid surgical decompression. However, some patients, if asymptomatic, may be treated with close clinical observation and serial imaging. Although rare, rapid spontaneous resolution of epidural hematomas in the pediatric population has even been reported, with only seven cases in the literature. Numerous theories have been proposed to explain the pathophysiology behind these cases, including egress of epidural collections through cranial discontinuities (fractures/open sutures), blood that originates in the subgaleal space, and bleeding from the cranial diploic cavity after a skull fracture that preferentially expands into the subgaleal space. We report the case of a rapidly resolving epidural hematoma in a 13-year-old boy. This case allows for more detailed inferences to be made concerning the nature of the epidural hematoma's resolution, as it is the first reported case in which an intracranial pressure monitor has been utilized. We also review the literature and discuss the nature of rapid spontaneous epidural hematoma resolution.

Spontaneous Rapid Resolution of Acute Epidural Hematoma in Childhood

“…The literature research reveals 8 pediatric cases excluding our case [6]. However, there are 5 adult cases [7].…”

Spontaneous Decompression of Extradural Hematoma Through Skull Fracture

“…8,14,18,22 It is further facilitated by increase in intracranial pressure that creates a pressure gradient and forcing out the clot from epidural space to the subgaleal space through the fracture. [3][4][5][8][9][10]18,19,21,23 The most appropriate management modality for the management of EDH is determined by the size and neurological status of the patient. [1][2][3][4] However for smaller lesions, careful followup, monitoring, and nonoperative management have been recommended.…”

“…[1][2][3][4] However for smaller lesions, careful followup, monitoring, and nonoperative management have been recommended. 3,4,6,[8][9][10]14,[17][18][19]21,23 In view of smaller size and further reduction in clot volume, a nonoperative management was offered to the patient. The learning points in present case include that not all extradural hematomas will increase in size over a period of time and although rare in contrast to this, in a subgroup of patients the size and volume of the hematoma can further decrease.…”

Rapid Spontaneous Resolution of Acute Epidural Hematoma: A Case Report and Review of the Literature

“…According to another theory, bleeding from the diploic space during early phases of trauma spreads into the epidural and subgaleal spaces through fracture and passage into the subgaleal space from the epidural space happens due to the p0ulsatile effect of the brain (6). Tataryn et al (10) have published a case of spontaneous resolutions without ICP increasing. This may have ultimately contributed to relatively lower pressure in the subgaleal space compared to the intracranial pressure and acted as a driving force, decompressing the hemorrhage into the subgaleal space.…”